Innovative vascular surgery at AAMC spares a patient a long road to recovery
To reach the sidelines of the soccer field where her son’s game was about to get underway, Liz Mackenzie had to walk the distance between the parking lot and the field. But she could barely make it.
“I was walking with a group of people,” she said, “and I couldn’t keep up. The pain in my legs had reached the point where I had to stop and rest and then start walking again. I decided then and there that I’d had enough and it was time to find out what was wrong.”
What was wrong was vascular disease; specifically, peripheral vascular disease (PVD). In one sense, Ms. Mackenzie was fortunate. Vascular disease in one artery makes it likely that other arteries are affected, although the carotid (neck) artery, renal (kidney) artery, or the abdominal aorta may not send a danger signal with obvious symptoms—until it’s too late. PVD in the legs often does have noticeable symptoms, such as the pain Ms.Mackenzie felt.
Her primary care doctor readily understood the implications of those symptoms and referred her to John Martin, M.D., and the AAMC Vascular Center. The tendency of PVD to affect arteries in more than one location proved all too true in Ms. Mackenzie’s case. An ultrasound scan showed 99 percent blockage in her carotid artery as well as nearly total blockage both in the femoral artery in her leg and in her iliac arteries.(Iliac arteries branch off from the lower part of the aorta to deliver blood to the lower limbs.)
The blockage in Ms. Mackenzie’s carotid artery represented a serious risk for stroke and therefore was the highest priority. To remove the plaque from her carotid artery, Dr. Martin performed a surgical procedure called a carotid endarterectomy. The plaque in her femoral artery could be removed with a minimally invasive procedure called a remote endarterectomy, a procedure pioneered by Dr. Martin and one for which other surgeons come to AAMC for training in its techniques.
That left the buildup in her iliac arteries, which previously would have called for highly invasive bypass surgery: a large incision, clamping off major blood vessels, two to three days in critical care, six to 10 days in the hospital, and six to eight weeks of recovery. Thus, under the conventional surgical wisdom in place at the time, Ms. Mackenzie faced the prospect of three different procedures: one moderately invasive (carotid artery), one minimally invasive (femoral artery), and one highly invasive (iliac arteries). Surgeons at AAMC’s Vascular Center, however, had other ideas.
The benefits of experience and expertise
Just a few years ago, removing plaque from the femoral artery by means of remote endarterectomy was seen as a quantum leap in vascular surgery. Dr. Martin, medical director of the AAMC Vascular Center, played a central and very visible role in introducing the procedure to the U.S. and refining its techniques. Today, the Vascular Center is one of the leading centers nationally for remote endarterectomies. Together with Jon Hupp, M.D., and Mark Peeler, M.D., they perform the most remote endarterectomies in the country.
This comprehensive expertise was good news for Ms. Mackenzie. Instead of performing two additional procedures following the carotid endarterectomy, Dr. Martin and the Vascular Center surgical team performed a remote endarterectomy on the femoral artery and then employed the same surgical techniques to remove plaque from the iliac arteries—all at the same time, all in one minimally invasive procedure.
Instead of a third operation, two nights in critical care, days in the hospital and weeks in recovery, Ms. Mackenzie was on her way home the next day and back to normal within a few weeks.
Dr. Martin said, “We’re participating in major national clinical trials for procedures in every area of vascular surgery. That participation becomes possible because of the degree to which we’re involved in training other surgeons, a strong emphasis on research, and a national profile in the field. It’s why we’re at the forefront of the development of new technology.”
Ms. Mackenzie gave high marks to the Vascular Center staff. “I can’t say enough about Dr. Martin and everyone at the Vascular Center. I had no idea what I was in for and being in their hands somehow made it all seem manageable. But it was more than just the care; it was also about being treated so well, the kindness and the individual attention.”
A PVD Primer
The “peripheral” in PVD refers to disease in the arteries located away from the heart and brain. These arteries carry blood to the extremities— legs, feet, arms and hands.
Like its close cousin cardiovascular disease, with PVD as the build-up increases, it restricts the blood flow to the legs resulting in pain while walking, pain at rest, or ultimately gangrene. This same process may affect carotid arteries in the neck leading to stroke, and the arteries to the kidneys leading to kidney failure and high blood pressure. Both can occur without warning. Aneurysms are another form of vascular disease and are the result of weakening in the wall of the arteries. When this occurs in the aorta, it can lead to rupture and sudden death. Risk factors for PVD include: smoking, being overweight, high blood pressure, diabetes, lack of exercise, and elevated cholesterol. Heredity and age also play important roles.